Magical Thinking

One of my patients suffers from chronic constipation due to irritable bowel syndrome. During the literally twenty years since she was first diagnosed, her symptom pattern has remained remarkably consistent: she has perhaps 1-2 bowel movements per week, occasionally accompanied by some mild cramping. Even she admits the symptoms are more a bother than a worry. And yet every time I prescribe a new medicine for one of her other ailments, within a day or two she calls me up complaining that it’s causing her to become constipated. When I ask if she means that while on the new medicine she has fewer bowel movements or more abdominal pain, her answer is always no. Yet she adamantly refuses to continue with the new medication, insisting it’s the cause of a symptom complex she’s had for two decades. And no matter how cogently I argue that the new medicine can’t be to blame (and I’m always careful to pick medicines not known to cause or exacerbate constipation), she refuses to continue with it.

Though certainly she could be right about one or even two pills exacerbating her constipation, the likelihood that all sixteen pills I’ve given her have caused the same exact symptom in the context of the symptom already existing is just too far-fetched. A much more likely explanation is that she’s indulging in magical thinking.

Magical thinking is defined as believing that one event happens as a result of another without a plausible link of causation. For example: “I got up on the left side of the bed today; therefore it will rain.” The problem with this definition, however, is that exactly what constitutes “a plausible link of causation” can be difficult to pin down. If we were to take this phrase to its logical extreme, we’d have to consider a belief in anything that hasn’t been scientifically proven to represent magical thinking.

Perhaps, then, a more nuanced definition of magical thinking would be believing in things more strongly than either evidence or experience justifies. Though I can’t prove the sun will rise in the East tomorrow, because it has every day since I’ve been alive, such a belief couldn’t then be said to represent magical thinking. But because every person who’s ever jumped off a building or a bridge has gone down and not up, believing that flapping my arms hard enough would enable me to float into the sky certainly would.

Problems with this definition remain, however. For one thing, we have to believe things without proof to function in the world. If we refused to believe what our doctors, plumbers, electricians, barbers, or nannies told us without first being shown incontrovertible evidence, our lives would come to a grinding halt. For another thing, some questions we’re burning to answer aren’t necessarily provable or disprovable. An estimated 90% of the American people believe in God, yet no evidence for God’s existence has ever been demonstrated scientifically—and further, some would argue, doesn’t need to be. Which would mean that technically 90% of the American population is guilty of magical thinking (a statement, I imagine, that puts me at risk for becoming unpopular with 90% of you).

On the other hand, maybe not. As much as we yearn to know truths about the world around us (and inside us), we can only ever see objective reality through the lens of subjective experience. We may all agree objective evidence abounds for the existence of gravity, but that’s only because we all have the same subjective experience of having our feet pulled back to Earth every time we take a step.

Which opens up the possibility that we could conclude something is true for which there is only subjective evidence or experience (meaning, not objectively demonstrable to anyone else) and not be guilty of magical thinking. If eating highly processed carbohydrates (“white death” my wife calls it) reproducibly makes me feel sleepy or irritable, concluding the former caused the latter would be entirely rational, yet impossible for me to prove to anyone else.

I think we can say, however, there exists a world of difference between a thought process that leads you to conclude it will rain today because you awoke on the left side of your bed and a thought process that leads you to conclude life is eternal because you’ve had a vivid memory of a past life. You could certainly question the validity of such a memory—or even the sanity of such a person—but, unlike with the first example, not the thought process that created the belief. In the second example, there is at least a reason for having the belief.

We can’t escape the intrinsic subjectivity with which we experience and interpret objective events. The best we can do is rigorously question the criteria we use to decide something is true. I suppose, then, what I’m ultimately arguing for is a constant, well-balanced degree of healthy skepticism about everything.

WHY WE SHOULD ALL AVOID MAGICAL THINKING

Clear and sophisticated thinkers remain consistently wary of the influences that put them at risk for magical thinking, always cognizant that why they believe what they do is influenced by so many things besides their reasoning minds:

What their parents taught them from an early age.

What they want to believe is true.

What their experience suggests should be true.

Improving the criteria we use to judge the truth of things is difficult. But because what we believe ultimately determines how happy we’re capable of feeling, we must constantly try. After all, the risks of indulging in magical thinking are quite serious:

Not making the necessary effort to achieve our goals. If we believe, for example, in the Power of Attraction as popularized by the book, The Secret, then we’re at risk for believing all we have to do is put out a clear enough visualization of what we want and wait for it to come to us. Unfortunately, we may find ourselves waiting a long time. How often do you find yourself hoping for something to happen when you should be doing something to make it happen?

Making bad choices. Five of the 16 medications my patient has now refused to take are blood pressure medications. As a result, her blood pressure has remained uncontrolled for several years, placing her at significantly higher risk for strokes and heart attacks.

HOW CAN WE STOP OURSELVES FROM THINKING MAGICALLY?

Magical thinking remains a subtle obstacle to making good decisions. But the more we observe ourselves, the more we can reduce our tendency to indulge in it:

Consciously identify your desires and biases. Write them down. Try to identify their cause. Work to free yourself from them to the best of your ability.

Demand proof when proof seems demonstrable. Try to remain intellectually “agnostic” toward what hasn’t been proven or isn’t provable, even if you find yourself emotionally inclined to believe it. Try to regard your belief as just that—an inclination—so that you’re not tempted to act with more confidence in your belief than is justified.

Beware the tendency to let others think for you. This is as insidious as it is widespread. A journalist presents a position about a topic of the day and has his or her opinion accepted as fact. One friend makes a statement about another and everyone accepts it as true without bothering to investigate themselves. Though I don’t agree with many of the principles espoused by Ayn Rand in her book, The Fountainhead, the point she makes about how so many of us subjugate our judgment to others is worth taking to heart.

We all tend to cling not only to the things we believe but also the reasoning that leads us to believe them. This likely explains why, despite all my efforts, I was never able to break through my patient’s magical thinking about the cause of her constipation before I left the University of Chicago.

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I attended a lecture by Dan Ariely, behavioral economist and author of “Predictably Irrational,” this weekend which plugs neatly into your post. Some of Ariely’s main points were that we make errors in perception all the time that lead to erroneous conclusions; that we imagine we are exercising agency when, inevitably, it’s the environment that determines what we can choose (including the mental “environment,” of course); and that the more complicated the decision, the more likely we are to adopt the default position (i.e. the one the environment makes it easier for us to take). I guess you could say that magical thinking is a kind of default place in many people’s subjective environment.
I am especially interested in your suggestions for avoiding magical thinking and I wonder if the first step doesn’t have to be a predisposition to think one is probably missing something (or a lot of things). Once you are standing on your convictions (belief system) it’s difficult to see what you are disregarding.

I am curious to know what your thoughts are about findings that people who are depressed tend to hold more accurate perceptions of reality than do people who are not.

rdp: Glad you liked the post. I think your point about avoiding magical thinking by beginning from the presumption that we’re “missing something” (meaning, in my mind, that we should always view our basic assumptions with a healthy bit of mistrust) is excellent. If we’re too attached to our belief systems or ways of reasoning, we’ll always miss answers lying outside of our current experience that are nevertheless true (and who among us currently has all the answers they want?).

Regarding the idea that depressed people hold more accurate views of reality—by which I presume you mean the view that few things are actually within our control and death is the final end, etc—presumes that “more accurate perceptions of reality” are by definition negative. I used to think that was true, but now I’m not so sure that such negative perceptions are any more likely to be true than overly positive ones. For example, regarding the issue of how much we control: if you define “control” as having complete sway over outcomes we want, we have to admit none of us have control over anything. What we do have, however, is influence. We can realistically expect to be able to strongly affect outcomes even if we can never guarantee them. I think the ultimate cause of depression (as I wrote in The True Cause of Depression) remains a distorted belief about what we do and don’t have power over and what having power over something actually means. I continue to be astounded by the human capacity to make determinations and carry them out, despite what “reality” might suggest is possible or not. So perhaps people are depressed more because they hold unrealistic views of what they can accomplish rather than more realistic views about the nature of reality.

Yes! Yes! So the depressed person suffers, too, from not starting with the presumption that s/he is likely missing something(s).

I will have to read “The True Cause of Depression.” My sense is that depression needn’t always involve a distorted sense relating to power; my experience suggests there is often a deep source of grief relating to a recognition (usually unconscious) that one is alienated from what gives other people satisfaction. In other words, it is a socially-constructed condition. If the social environment makes it difficult or impossible for the person to function in a way the person experiences as acceptably authentic, a feeling of powerlessness is created. Maybe depressed people “see” things that culture encourages us to deny (yes, death as final end, but also that good people often have little satisfaction in life and bad ones a great deal, or equal effort rarely guarantees equal reward), and are unable to find a way to “see” positives that would gratify them because the culture they live in doesn’t recognize or name them.

There is a connection here somewhere with magical thinking, but it will take me a bit of time to tease it out. Maybe down deep your patient doesn’t feel her constipation has been sufficiently recognized (even though she acquiesces in calling it only a “bother”) and thus makes everything about this issue. Or maybe she cannot accept the reality that her body is the source of its own disfunction. I do believe these are puzzles we can solve if we keep asking ourselves what we are missing, however….

Thanks for your patience with my long-winded comments!

rdp: Your insight about my patient couldn’t be more right. Though she says her constipation is only a bother, I don’t actually believe her. I think if it were controlled to her satisfaction, her tendency to link it to everything else I do for her might disappear.

I know that my response won’t be anywhere near as intelligent as y’all have been. With that said, I wanted to tell Alex that your recent essay on “Magical Thinking” has really brought back some memories that I haven’t thought about in a bit. When I was a little child—well maybe not that little, I was 5—my mother left my brother and I in an apartment and never came back. And I remember growing up thinking that if I was just good enough or smart enough or prettier or taller or thinner or what have you, she would come back. It didn’t work like that, as what I was thinking wasn’t based in reality at all, just wants and wishes and needs. It just took me until I was an adult to realize that. Your essay just brought it all back.

Brendalee: What an awful, awful thing that happened to you. It reminds me that everyone’s thinking always SEEMS rational to them and that there’s great value in uncovering events from childhood that have stuck you with “irrationalities.” And your response was as articulate as it was instructive. I’m so glad you’ve broken through as an adult the magical thinking this experience triggered in you as a child.

My IBS-constipation predominant patients have crowed their delight to me after finally trying this strategy:

Take generic magnesium tablets or capsules starting at 250 mg BID

and

1/2 teaspoon of psyllium with >8 ounces of water BID

Gradually increase, if necessary, the magnesium, to 500-750 mg (or more) BID, and the psyllium to 1 teaspoon BID (more not usually indicated)

Aim for 1-3 soft fluffy disintegrating BMs per day. Once this is accomplished, continue the same regimen every day, year in and year out. Take extra magnesium if taking any medicine that is even remotely constipating.

On several occasions I have actually read the same instructions from a patients’ chart notes from a year or two earlier, which they had sat and listened to me dictate (but then had promptly dismissed as not-gonna-work-for-me hocum.) It helps if I relate to them how I rarely learn anything truly important the first time through either. I then promise them they will have relief, but at any rate, I will see them again in just a week or two. (Then we add either more magnesium, or Miralax…) Usually they cancel that appointment, with a message about how well it’s working. I send a message back through my secretary that they are never to stop the regimen, even if they are sick and can’t eat anything else. After that we briefly confirm at every visit that they are still on the regimen, and still satisfied with it. They almost always are, and it’s neat to see how much pleasure and comfort it gives someone to have total control over this problem.

Re: depression postulations…I think you two are talking about flip sides of the same coin, and are both on target. Just looking at the same thing through different lenses, or from a different angle, helpful in each case.

sjl

(You really don’t have to post this on your blog—just wanted to share this with you, though I suspect you already knew this stuff. But I am frequently amazed at how many of my colleagues fail to push the simple (effective) stuff…)

Jessy: I’ve used a regimen similar to this quite often. As an old GI attending teacher of mine once said, “If they’re constipated and taking a cathartic/stool softener/whatever and it’s not working, what they need is more!” I’ve posted your comment as it might be helpful to others. Thanks for making it.

I think we have to use our own discrimination—whether it’s trusting our own experiences or those of others—we have to make the decision for ourselves. Unfortunately for the lady you spoke of she was doing just that.

Just as we all have different levels of ability at riding bikes, unfortunately we all have different levels of ability at discerning the truth.

Julien: I think that’s a really good point, actually. Discerning the truth really is a skill some are born better at than others. I wonder if (and hope that) it’s a skill that can be improved on with practice.

A small criticism, but you’ve used magical thinking as an umbrella to cover what are probably properly considered logical fallacies. Although magical thinking and logic both cover what is essentially a naive (or immature) connection between cause and effect, magical thinking tends to involve the symbolic realm whereas logic covers rational thought. Rational thought is often learned and can be sophisticated, magical thinking probably not so much.

Recently someone close to me was going through a difficult legal situation and had to go to court for the resolution. Afterward, in the parking lot, as a group of us did a recap, he announced that he knew it would be a good outcome because he had found a gold bracelet that had been lost for some months. Turned out, he dressed for court that morning, put on his suit jacket, reached into the pocket and there it was. He declared it “a God thing.”

My mind reeled at the incomprehensibility of this declaration since, to me, the bracelet had been simply forgotten in that pocket and the jacket not worn since last autumn, when the bracelet was “lost.” I couldn’t, and still can’t, see it as divine communication, but a refusal to grasp the reality of the circumstances. The bracelet was in the coat all of this time and the good outcome came as a result of willingness to do what was necessary along with a judge who was not sidetracked by irrelevant flotsam being thrown at the court.

The trouble with this magical thinking is that many people I encounter place all their trust, and subsequently their lives, in signs, portents, and horoscopes, or as you mentioned—hocus pocus things like “The Secret.” They refuse to grasp the concept that they are responsible for all of these events. The real secret is that everything one has or doesn’t have in their lives is a result of the choices one makes, with not making a choice also being a choice. All the little choices are equally as important as the big ones, in fact might even be more influential on a cumulative continuum.

My husband tells of a man he knew who from a very young age wanted to be an astronaut. Even as a boy all of his choices were centered around becoming an astronaut, and if an activity presented did not further him toward the goal, he did not do it. He chose to focus completely on being an astronaut, for years from everything he ate to exercise, studies, and leisure time activities. Eventually, his dream came true and he went on to participate in five space flights, logging in 36.5 days in space. His name is Robert L. “Hoot” Gibson. Hoot tells of his early focus when he gives speeches about his experiences, the lesson being that if one wants something to come to pass, it is through making choices to get closer to the goal that makes it happen, always asking oneself “Does this get me closer to my goal?”

I think Hoot would laugh at the notion that just concentrating or wishing for something will make it happen. It brings to mind the old saying: Wish in one hand and poop in the other and let’s see how fast each one fills up. (Sorry to go there).

As an occupational therapist working in an acute care hospital, I often experience magical thinking in my patients. It’s whenever they are unable to perform some basic self-care task (such as get out of bed) and refuse to even try it, saying “Oh, I’ll be able to do that when I’m at home and in my own bed.” My co-worker and I actually call that the “Magic Door” syndrome.

I like your blog, by the way. I discovered it through a link from the NYTimes.

The post and the discussion are quite enjoyable here. I can’t recommend strongly enough the book by Andrew Newberg and Mark Waldman “How God Changes Your Brain” even though I think the title is misleading. It’s well referenced and great discussion of scientific studies of subjective experiences and how various religious practices can effect the brain. Chapters 8 and 9 really are the reason I like the book so much as it moves beyond discussion to give a current summing up on what are likely the best practices based on published studies to positively affect our brain’s plasticity.

Well, I will disagree with you about the law of attraction. “The Secret” did not say that action was unnecessary. What it promoted was that one should take inspired action. For example, let’s say that someone is looking for a job. A conventional approach would be to look in the classifieds or ask people for contacts. But sometimes, the conventional approach does not work. If we base our approach on everything that we have seen or experienced, that just limits us to creating what we know is possible. So then, we may just look at ads or ask people for contacts. But maybe the job we want cannot be found that way. I’ve had the experience of manifesting jobs by using the law of attraction. I’ve had people I barely know offer me jobs when I was not actively looking nor had I put the word out. I know a woman who was offered a job while she was enjoying herself on vacation. She wasn’t looking, either. I think anyone who dismisses the law of attraction is really missing out on some amazing possibilities.

The law of attraction is not about giving up your power, but taking responsibility for achieving what you want. The story of the astronaut referenced above is a good example of the law of attraction. You start by focusing on what you want. You open yourself to guidance on achieving your goal by listening to the thoughts you get about it. You take action when it seems right. It really is about focusing your energy to achieve a goal as opposed to just taking action because you think that action will lead to your goal. Sometimes, action is unnecessary because it is easier than we realized. But it depends on the goal, really. If you think something will be a lot of work, it will be so. If you say that you must do X in order to achieve a goal, then you do not allow it to be realized in other ways.

I agree that “The Secret” did not do a good job at explaining the law of attraction. It is a good introduction and motivational tool. But if you really want to understand the law, you should read “The Law of Attraction” by Esther and Jerry Hicks.

Magical thinking abounds in our society where opinions and factual distortions abound in our media. In fact, it’s no wonder that one might just descend into one’s own madness as you might as well. It’s no more crazy than the stuff you read about in the news or hear on TV, and those people get paid a LOT of money to misinform us.

But for those of us not quite ready for that (I’ll wait for the complete onset of Alzheimer’s, I’m only up to the “z” so far…lol), it can’t bear too much repeating that there are facts which exist despite someone’s opinion of them, critical thinking is not anti-American, and knowledge is really power. Thanks for sharing, Alex.

It’s funny to me your post on magical thinking was inspired by, or at least illustrated by, an example of a patient with IBS. My understanding is that very little agreement exists on the etiology of the condition, and that most experts will accept a “mind-body” type influence at work, at least in part. Is IBS “magical thinking” that somehow produces changes in intestinal function and enteroception? There is an association between depression and IBS, and decreased serotonin activity may be a contributing factor to both. but why do people have lower serotonin? I guess what I am saying is, it’s a bit of magical thinking to expect a specific treatment for IBS to work if the true cause of the condition is a mystery.

Spencer: Actually, in medicine we have many examples of specific treatments working for diseases whose cause is a complete mystery, including for example depression. No studies have ever shown low serotonin levels—or any specific neurotransmitter—cause depression. And though there isn’t agreement on what causes IBS, recent studies are beginning to shed light on it and are showing there are definitely measurable physical differences in the bowels of people with IBS compared to those without it.